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. 2017 Oct;37(5):387-392.
doi: 10.14639/0392-100X-1376.

Management of free flap failure in head and neck surgery

C Copelli  1 , K Tewfik  1 , L Cassano  1 , N Pederneschi  1 , S Catanzaro  1 , A Manfuso  2 , R Cocchi  1
Affiliations

Management of free flap failure in head and neck surgery

C Copelli et al. Acta Otorhinolaryngol Ital. 2017 Oct.

Abstract
in English, Italian

Free flap surgery is overall considered the gold standard in head and neck reconstruction, with a success rate of 95%. The management of a total flap necrosis and which solution, between a pedicled or a second free flap, is safer for a salvage procedure is still controversial. Object of this study is to describe the authors' management of total free flap loss in head and neck reconstruction and compare the choices and results to those reported in the literature. From January 2012 to January 2016, 149 consecutive free flaps were performed at the Maxillo- Facial Operative Unit of the Hospital Casa Sollievo della Sofferenza in San Giovanni Rotondo (Italy) for reconstruction of head and neck defects. Of these, 6 flaps were lost due to a total necrosis. In 5 cases it was decided to harvest a second free flap, and in the remaining patient a temporalis muscle flap was used. All the free salvage flaps were successful, without complications and with a good aesthetic and functional recovery. Analysing the data obtained, and comparing them with those reported in the literature, it can be concluded that a second subsequent free flap can be considered an ideal and safe procedure in salvage surgery.

L’utilizzo dei lembi liberi è oggi considerata l’opzione di prima scelta nella ricostruzione dei difetti testa-collo, con una percentuale di successo di circa il 95%. La gestione del fallimento di un lembo libero e quale soluzione, tra un secondo lembo libero e un lembo peduncolato, sia più sicura è ancora controversa. L’obiettivo del presente lavoro è descrivere le opzioni adottate dagli Autori e confrontare le scelte e i risultati ottenuti con quelli riportati in letteratura. Dal Gennaio 2012 al Gennaio 2016, presso l’UO di Chirurgia Maxillo-Facciale dell’Ospedale Casa Sollievo della Sofferenza, sono stati allestiti 149 lembi liberi per la ricostruzione di difetti interessanti il distretto testacollo. Di questi, 6 lembi sono stati persi a causa della comparsa di una necrosi totale nel post-operatorio. In 5 casi si è scelto di allestire un secondo lembo libero, nel restante paziente invece è stato utilizzato un lembo di muscolo temporale. Tutti i lembi liberi di salvataggio allestiti hanno avuto successo, senza complicanze e con un buon recupero estetico e funzionale dei pazienti. Analizzando i dati ottenuti e confrontandoli con quanto riportato in letteratura, è possibile concludere come l’allestimento di un secondo lembo libero costituisca una procedura sicura e ideale come salvataggio dopo necrosi totale di un precedente lembo.

Keywords: Flap loss management; Free flap failure; Head and neck reconstruction; Salvage free flap.

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